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Effects of education level on rates of obesity differ by race

The JAMA Network Journals

CHICAGO - There are significant racial differences in the association between education level and weight change for middle-aged women, according to an article in the March 14 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

While overall rates of obesity have increased dramatically in the United States, the prevalence rates of overweight and obesity remain disproportionately higher for African-American women than for white women, according to background information in the article. Although the excess weight observed in African-American women has been primarily considered a result of low socioeconomic status (SES), evidence from previous studies suggests that SES may influence overweight and obesity for women of different racial groups.

Tené T. Lewis, Ph.D., of Rush University Medical Center, Chicago, and colleagues examined the interactive effects of race and three levels of education: low, high school or less; moderate, some college; and high, college degree or more, on body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) and changes in BMI over four years in 2,019 middle-aged African-American and white women from the Study of Women's Health Across the Nation (SWAN). At a baseline examination and annually thereafter, participants underwent a standard protocol that included questionnaires, height and weight measures and clinical tests.

There were no differences in BMI in African-American and white women with a high school education or less, the researchers found. "... black-white disparities in BMI widen with increasing levels of education," they write. "We observed significant racial differences in the effects of education on weight for middle-aged women. At all levels of education, African-American women were equally heavy, while white women were thinner with increasing baseline educational attainment. These results are consistent with previous studies of young girls, adolescents and adult women. In this respect African-American women do not seem to benefit from educational attainment in the same way that white women do."

"The lack of an observable benefit on BMI for educated African-American women is particularly alarming given their disproportionately high rates of obesity and obesity-related illnesses," the authors conclude. "Because race-education patterns appear to be well established by midlife, prevention efforts aimed at reducing the prevalence of obesity in African-American women should begin in adolescence or early adulthood."


(Arch Intern Med. 2005; 165:545-551. Available post-embargo at

Editor's Note: The Study of Women's Health Across the Nation (SWAN) was funded by the National Institute on Aging, The National Institute of Nursing Research and the National Institutes of Health Office of Research on Women's Health, Bethesda, Md.

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